Diabetes affects approximately 10 million Americans and is a major cause of blindness. Almost all persons with diabetes will develop some degree of diabetic retinopathy during their lives. Given the ability to diagnose diabetic retinopathy in an asymptomatic form, the recent advances for the effective treatment of the disease, and the underutilization of these available technologies, the dissemination of this information to persons with diabetes is crucial to maximize the quality of care among this group. The Diabetes Retinopathy Awareness Program is being proposed to address these issues. It is a randomized controlled educational Intervention trial to be conducted in Suffolk County, New York. The study aims to control visual loss from diabetic retinopathy in the community by evaluating various methods of increasing the use of ophthalmologic services among persons with diabetes. The proposed trial would incorporate a rigorous study design and evaluation of the effectiveness of various strategies for behavioral change. Methodology and intervention techniques will be drawn from the fields of epidemiology, clinical trials, health education and promotion, information dissemination and disease registration. Persons with diabetes will be identified from multiple community sources, such as pharmacies, physician offices and health clinics, health care workers, mass mailings from the American Diabetes Association and the Long Island Lighting Company, mass media and other networks. Through these channels, the study expects to identify over 2,500 individuals over the age, and enroll 840 persons into the educational intervention trial. Eligibility for the trial will be based on lack of an ophthalmologic examination within the last two years. Eligible individuals will be randomized into a nonintervention control arm, a single one-time intervention arm or a multiple-component intervention arm and followed for two years. Survey data will be collected at baseline, midpoint and at trial completion to obtain information on knowledge, attitudes, beliefs and practice regarding diabetes, diabetic related eye disease and ophthalmologic care. Data on eye examinations, which are the major study endpoint, will be confirmed by the participants' ophthalmologists. The effectiveness of each intervention will be evaluated and results used to develop a prototype intervention model, which can be used in other communities. The study draws methods from well established health intervention schemes in use for other diseases, and in other populations. A major strength of the proposed study is its extensive support by community organizations and the local ophthalmologists. Its results will provide data to evaluate the success of various community based methods to recruit persons with diabetes for educational interventions; it will also test and compare various types of interventions. This information will assist in creating future intervention models. In addition, it will develop methods to inexpensively, yet effectively, track changes in health care utilization in a population over time.